Large sample tests for binary outcomes in fixed-dose combination drug studies

Several test statistics are developed for testing the hypothesis that the combination of two drugs at a fixed-dose regimen is more effective than both of the single drugs used alone with respect to a dichotomous response variable. The response probability, logit, and arcsine-root scales are considered. The power function and the significance level are derived for large samples. For the sample size per group of 20 or greater, the power and type I error rate can be accurately calculated using the large sample power function when the response probability ranges from 0.2 to 0.8. These tests have similar power behaviors. In small samples, the large sample power functions of two of the tests can severely underestimate the type I error rate while overestimation can occur with one other test. The utilities of these tests are extended to unbalanced sample size cases. Generally speaking, there is a loss of power with unequal sample size allocation, but the loss is not severe.

Poststroke depression among the Chinese elderly in a rural community

BACKGROUND AND PURPOSE

A door-to-door survey was conducted in two townships in the Kinmen islets to investigate the prevalence and other characteristics related to depressive disorders of stroke survivors in an elderly Chinese population.

METHODS

Our target population comprised the registered residents > or = 65 years old (n = 2056) of a total population of 26 105 on August 1, 1993. All participants answered a questionnaire, filled in a Geriatric Depression Scale-short form (GDS-S), and received a neurological examination. Depression was defined as a GDS-S score > or = 5.

RESULTS

Twenty-eight of 45 stroke survivors (62.2%) and 491 of 1471 nonstroke subjects (33.4%) were classified as depressed. The frequency of stroke survivors' depressive disorders was significantly higher that of nonstroke subjects (P < .001). Multiple regression analysis indicated that GDS-S scores were most related with the activities of daily living (R2 = .19, P = .004) in the stroke survivors.

CONCLUSIONS

Depressed mood was common after stroke, and activities of daily living were an important factor for depression in stroke survivors in the community.

Swallowing difficulty in Parkinson's disease

Dysphagia is a frequent and potentially serious complication of Parkinson's disease (PD). We examined the oropharyngeal swallowing ability in 19 PD patients (15 men and 4 women, mean age 68.42 years, mean Hoehn and Yahr stage 1.8) using modified barium swallow before and after administering oral levodopa (in combination with benserazide). Twelve (63.2%) patients demonstrated objective evidence of swallowing abnormalities; although only six patients (31.6%) had subjective complaints. Vallecula sinus and pyriform sinus residues were the most frequent abnormalities (47.4% and 42.1%); followed by delayed swallowing reflex (26.3%). Three patients demonstrated silent aspiration. In the 12 patients with abnormal swallowing, six (50%) showed objective improvement after levodopa treatment, while the remaining six showed no change. Of the former group of six, one patient showed improvement in the oral phase, but deterioration in the pharyngeal phase. We concluded that PD patients had a high percentage of objective swallowing abnormalities which could be reduced in half of the patients through the administration of levodopa treatment.

Role of radioisotope penile plethysmography in the evaluation of penile hemodynamics in impotent patients

Nineteen impotent patients were included in the study. Radioisotope penile plethysmography using technetium-99m-labelled RBC was performed on each patient before and after intracavernosal injection of prostaglandin E1 (PGE1) for quantitating the penile hemodynamic change. The peak penile blood flow (PPF) and penile blood volume change (dPV) were evaluated. The results revealed that (a) the PPF values (mean 2.24 +/- 1.38 ml/min) of all patients were lower than that of the patients with no arterial changes previously reported, and (b) there was good correlation between PPF and dPV (r = 0.75). We conclude that quantitative radioisotope penile plethysmography coupled with intracavernosal injection of PGE1 is a valuable method for the objective evaluation of the penile erectile response of impotent patients, and that the PPF values of the impotent patients with arterial insufficiency might be a reliable parameter of penile volume change.

Correlation between patterns of antral contractility and gastric emptying of radiopaque markers

OBJECTIVES

Gastric clearance of radiopaque markers (ROMs) has been proposed as an easy and noninvasive technique for assessment of gastric emptying. This study was conducted to evaluate the role of antral obliterating contractions in gastric emptying of ROMs in healthy volunteers.

METHODS

Fifteen healthy volunteers, 12 males and three females, aged 21-38 yr, were enrolled in this study. Simultaneous recording of scintigraphic solid phase gastric emptying, gastric clearance of ROMs, and gastric manometry were performed after an overnight fast. The data of scintigraphic solid phase gastric emptying were expressed by half-emptying time (t1/2). The ROMs remaining in the stomach were counted fluoroscopically 2.5 and 4.5 h after the test meal. The time for the appearance of antral obliterating contractions after the meal was calculated.

RESULTS

Six subjects (40%) passed all 10 ROMs after 4.5 h of recording. Among these six subjects, five had antral obliterating contractions 190-251 min (mean 232.2 +/- 24.3 min) after the test meal. There was no significant difference in t1/2 between subjects with or without antral obliterating contractions within the 4.5 h of recording.

CONCLUSIONS

There was a considerable intersubject variation in the time of first antral obliterating contraction after the test meal. In the healthy volunteers, all ROMs were passed when there was a postprandial antral obliterating contraction. However, some of the ROMs still passed from the stomach in the absence of antral obliterating contractions.

Comparison of risk factors for lacunar infarcts and other stroke subtypes

BACKGROUND

Lacunar infarction (LI) is an ischemic stroke subtype with unique clinical, radiological and pathological features. Its relation to other stroke subtypes is unclear. To better understand the underlying pathological process of LI, we compared the risk factors of LI with those of other stroke subtypes.

METHODS

During the study period (from January 1, 1990 to December 31, 1991), 240 consecutive patients with first-ever strokes admitted to the stroke unit of our hospital were enrolled to the study and were classified into one of the four stroke subtypes (52 with LI, 80 atherothrombotic infarcts, 38 cardiogenic embolism and 70 brain hemorrhage) based on their computed tomography (CT) and clinical features using the guideline developed by the National Institute of Neurological Disorders. Eighty outpatients of similar age who had either low back pain or cervical spondylosis were recruited from the clinics of Neurology to serve as non-stroke controls. Data collected included demographics, lifestyle, and other vascular risk factors. Detailed physical and neurological examination, blood biochemistry and Doppler ultrasound on cervical vessels were performed.

RESULTS

Our investigations revealed that LI is a common stroke subtype accounting for 21% of all first-ever strokes in our hospital. Like ischemic stroke patients, those with LI were much more likely to have hypertension, diabetes, heart disease and carotid disease when compared with non-stroke controls. Patients with brain hemorrhage had less history of diabetes and lower levels of cholesterol than LI patients.

CONCLUSIONS

LI patients seemed to share more risk factors with ischemic stroke patients than with brain hemorrhage patients. These shared risk factors suggest a possibly similar underlying pathological process between ischemic strokes and LI patients. Careful screening for those risk factors should be part of the mandatory clinical management for the prevention of LI.

Inhibition of synaptic transmission and epileptiform activity in central neurones by fluspirilene

1. Recent studies have shown that fluspirilene, a dopamine D2 receptor antagonist which is a long-acting neuroleptic useful in the maintenance therapy of schizophrenic patients, also displays Ca2+ channel blocking activity. In the present study, we have investigated the effect of fluspirilene on synaptic transmission and epileptiform activity induced in slices of hippocampus and amygdala. 2. Fluspirilene reversibly suppressed the field excitatory postsynaptic potential (f-e.p.s.p) in a concentration-dependent manner in the area CA1 of the hippocampus without affecting the size and shape of fibre volley. Fluspirilene also inhibited the intracellularly recorded e.p.s.p. in amygdala neurones without affecting the resting membrane potential or neuronal input resistance. 3. Fluspirilene increased the ratio of paired-pulse facilitation suggesting a presynaptic mode of action. 4. Epileptiform activity induced in the disinhibited slices was suppessed by fluspirilene in a concentration-dependent manner. This antiepileptic effect was occluded in slices pretreated with the adenosine A1 receptor agonist, N6-cyclopentyladenosine (CPA). 5. It is concluded that fluspirilene-induced synaptic inhibition is probably due to a reduction in presynaptic Ca2+ currents. In clinical trials, the low incidence of seizures provoked by fluspirilene might be related to its intrinsic ability to inhibit synaptic transmission and epileptiform activity.

Detection of acute inhalation injury in fire victims by means of technetium-99m DTPA radioaerosol inhalation lung scintigraphy

Mortality and morbidity in fire victims are largely a function of injury due to heat and smoke. While the degree and area of burn together constitute a reliable numerical measure of cutaneous injury due to heat, as yet no satisfactory measure of inhalation injury has been developed. In this study, we employed technetium-99m diethylene triamine penta-acetic acid (DTPA) radioaerosol lung scintigraphy (inhalation scan) to evaluate acute inhalation injury in fire victims. Ten normal controls and 17 survivors from a fire accident were enrolled in the study. All patients suffered from respiratory symptoms (dyspnoea and/or cough with sputum). 99mTc-DTPA aerosol inhalation lung scintigraphy was performed in all subjects, using a commercial lung aerosol delivery unit. The degree of lung damage was presented as the clearance rate (k; %/min) calculated from the time-activity curve over the right lungs. In addition, the distribution pattern of the radioactivity in the lungs was evaluated and classified into two groups: homogeneous distribution and inhomogeneous distribution. A plain chest radiograph (CxR) and pulmonary function test (PFT) were performed in the same group of patients. The results showed that 6/17 (35.3%) patients had inhomogeneous distribution of radioactivity in their inhalation scans, and 11/17 (64.7%) had homogeneous scans. Five of the six patients with inhomogeneous scans were admitted for further management, and all patients with homogeneous scans were discharged from the emergency department and needed no further intensive care. The clearance rates of the right lung were 0.73%+/-0.13%/min for normal controls and 1.54%+/-0.58%/min for fire victims. The difference was significant, with a P value of less than 0.01. Using a cut-off value of 0.9%/min (all normal subjects were below 0. 9%/min), 14 (82.4%) patients had abnormal clearance rates of 99mTc-DTPA from the lung. In contrast, only three (17.6%) patients had abnormal CxR and three (17.6%) had abnormal PFTs. We conclude that (1) conventional CxR and PFT are not good modalities for evaluating inhalation injury in fire victims because of their low sensitivity, and (2) 99mTc-DTPA radioaerosol inhalation scintigraphy can provide an objective evaluation of inhalation injury during a fire accident and may be useful in therapeutic decision-making and disease monitoring.

Comparison technetium of Tc-99m disofenin cholescintigraphy with ultrasonography in the differentiation of biliary atresia from other forms of neonatal jaundice

Technetium Tc-99m disofenin cholescintigraphy (CS) and ultrasonography (US) are two major clinical methods used in differentiating biliary atresia (BA) from neonatal jaundice. To compare the diagnostic utility of these two modalities, 66 patients with neonatal cholestasis (15 BA, 3 choledochal cyst (CC), 32 neonatal hepatitis, 13 prolonged jaundice, 2 total parenteral nutrition, and 1 sepsis) underwent Tc-99m disofenin CS and US. The diagnostic sensitivity, specificity, and accuracy of CS in differentiating BA from other forms of neonatal jaundice was 100%, 87.5%, and 90.5%, respectively, and for US 86.7%, 77.1%, and 79.4%, respectively. Tc-99m disofenin CS after premedication with phenobarbital and cholestyramine is a convenient and reliable method of differentiating BA from neonatal hepatitis, with a diagnostic accuracy superior to that of US. However, US is the initial imaging procedure of choice in patients presenting with jaundice to rule out anatomic anomalies such as CC.

The Kinmen Neurological Disorders Survey (KINDS): a study of a Chinese population

We conducted an epidemiological study of several neurological disorders among the Chinese aged 50 years or older on the islet of Kinmen. All participants were interviewed and examined by neurologists. From the targeted population of 5,061 individuals, 3,915 (77.4%) of them completed the evaluations. Among the 4,087 individuals with whom face-to-face contact was made, the refusal rate was 4.2%. The disorders of interest were dementia, Parkinson's disease, essential tremor, stroke, transient ischemic attacks, and migraine. Among the 3,915 participants, 366 cases were found with 1 or more of the surveyed neurological disorders on the prevalence day, August 1, 1993, yielding a prevalence of 93.5/1,000. The purpose of this study, the general methodology, and some overall findings are presented in this communication in order to provide a common background for detailed findings on each disorder to be reported separately.

99Tcm-HMPAO-labelled white blood cell scans to detect acute appendicitis in older patients with an atypical clinical presentation

Forty-nine patients (age > 50 years) with an acute abdomen and suspected appendicitis, but with atypical findings, were included in the study. After the intravenous injection of 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) labelled white blood cells (WBCs), serial anterior images of the abdomen and pelvis were obtained after 30, 60, 120 and 240 min. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen equal to or greater than bone marrow activity was considered positive. Twenty-five patients had positive WBC scans, all of whom underwent laparotomy. Twenty-three of these patients were shown to have appendicitis; the other 2 did not. The other 24 patients had a negative WBC scan, 2 of whom underwent laparotomy and were shown to have appendicitis; the other 22 patients did not undergo surgery and showed no evidence of appendicitis during follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values of WBC scans for diagnosing appendicitis were as follows: 92.0%, 91.7%, 91.8%, 92.0% and 91.7% respectively. In conclusion, 99Tcm-HMPAO-labelled WBC scans provide a rapid and highly accurate method for diagnosing appendicitis in older patients with equivocal clinical findings.

99Tcm-phenylene imine phenol as a potential leukocyte labelling agent

The aim of this study was to evaluate 99Tcm-labelled phenylene imine phenol (99Tcm-Ph(IP)2) as a leukocyte label. The 99Tcm complex exhibits a neutral lipophilic character. The radiochemical purity of the 99Tcm-Ph(IP)2 was high both soon after labelling (94.5 +/- 1.2%, n = 7) and at 24 h (89.7 +/- 1.0%, n = 7). In a comparative study, the labelling efficiency of 99Tcm-Ph(IP)2 and 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) labelled leukocytes was 47.1 +/- 3.5% (n = 7) and 58.5 +/- 7.0% (n = 7) respectively. The viability of labelled leukocytes was greater than 90% for both 99Tcm complexes. The elution ratios of labelled leukocytes with 99Tcm-Ph(IP)2 at 1, 4 and 24 h were 10.1 +/- 3.5%, 17.2 +/- 2.7% and 23.0 +/- 2.4% (n = 7) respectively, while those with 99Tcm-HMPAO were 10.8 +/- 1.2%, 18.3 +/- 2.0% and 37.0 +/- 3.7% (n = 7) respectively. In conclusion, 99Tcm-Ph(IP)2, with good stability and significant leukocyte labelling efficiency, is a potential leukocyte label.

Expression of NGFI-B mRNA in a rat focal cerebral ischemia-reperfusion model

Cerebral ischemia is known to induce the expression of several immediate early genes (IEGs), including c-fos and c-jun, which subsequently regulate a number of late effector genes. In this study, we examined the expression of NGFI-B (or nur 77) mRNA in a rat focal cerebral ischemia-reperfusion model. NGFI-B is a member of the IEGs which encodes for a nuclear receptor and is rapidly induced by nerve growth factor (NGF). Northern blot analysis showed a rapid but transient enhancement of NGFI-B mRNA, a peak level for which was observed at 30 min of reperfusion following 60 min ischemic insult. At the peak level, quantitative analysis of the blot indicated a 12-fold and 4-fold increase of NGFI-B mRNA in the ischemic cortex and ipsilateral hippocampus, respectively, as compared to the sham-operated control. No apparent changes in mRNA levels were observed within contralateral sites of the cortex. Results from in situ hybridization showed that severe ischemia (60 min) resulted in a marked increase of NGFI-B mRNA throughout the entire ischemic cerebral cortex. The increase was particularly notable in the frontal, occipital, perirhinal and piriform cortical regions and in the dentate gyrus and CAI-3 regions of the ipsilateral hippocampus. A marked induction was also noted in the ipsilateral caudate putamen. Unlike the induction profile of NGFI-B mRNA, severe ischemia resulted in bilateral increases of its family gene, NGFI-A mRNA. The spatial induction profile is similar to that of NGFI-B mRNA in both hemispheres, except within the region of the contralateral dentate gyrus which showed low levels of NGFI-A mRNA. The expression pattern of NGF and BDNF mRNA, upstream genes of NGFI-B, were also examined. Interestingly the temporal and spatial expression patterns of BDNF mRNA were very similar to that of NGFI-A mRNA under the same conditions, whereas increased NGF and NGFI-B mRNA were observed only in the ipsilateral hemisphere. It is likely that multiple and/or overlapping pathways are activated subsequent to ischemic challenge which in turn are crucial for cel survival and/or functional recovery following focal cerebral ischemia.

In vitro and in vivo differentiation into B cells, T cells, and myeloid cells of primitive yolk sac hematopoietic precursor cells expanded > 100-fold by coculture with a clonal yolk sac endothelial cell line

The yolk sac, first site of hematopoiesis during mammalian development, contains not only hematopoietic stem cells but also the earliest precursors of endothelial cells. We have previously shown that a nonadherent yolk sac cell population (WGA+, density < 1.077, AA4.1+) can give rise to B cells, T cells and myeloid cells both in vitro and in vivo. We now report on the ability of a yolk sac-derived cloned endothelial cell line (C166) to provide a suitable microenvironment for expansion of these early precursor cells. Single day 10 embryonic mouse yolk sac hematopoietic stem cells wer expanded > 100 fold within 8 days by coculture with irradiated C166 cells. Colony-forming ability was retained for at least three passages in vitro, with retention of the ability to differentiate into T-cell, B-cell, and myeloid lineages. Stem cell properties were maintained by a significant fraction of nonadherent cells in the third passage, although these stem cells expressed a somewhat more mature cell surface phenotype than the initial yolk sac stem cells. When reintroduced into adult allogeneic immunocompromised (scid) hosts, they were able to give rise to all of the leukocyte lineages, including T cells, B cells, and myeloid cells. We conclude that yolk sac endothelial cells can support the stable proliferation of multipotential hematopoietic stem cells, thus generating adequate numbers of cells for study of the mechanisms involved in their subsequent development and differentiation, for in vivo hematopoietic restitution, and for potential use as a vehicle for gene transfer.

The influence of two bone agents (99Tcm-pyrophosphate and 99Tcm-methylenediphosphonate) on quantitative sacroiliac joint scintigraphy

Bone scintigraphy is an extremely sensitive method for the detection of focal bone disease. In many hospitals, quantitative sacroiliac joint scintigraphy is still a routine procedure in detecting sacroiliitis. In previous studies, both 99Tcm-methylenediphosphonate (99Tcm-MDP) and 99Tcm-pyrophosphate have been used for bone imaging. 99Tcm-pyrophosphate is eliminated more slowly than 99Tcm-MDP from the circulation and gives a higher background activity. We wished to discover the sacroiliac/sacral ratio (SI/S ratio) changes when using different bone agents. The aim of this study was to evaluate differences in SI/S ratios between the two bone agents. Forty-six control subjects, aged 31-50 years, with no history of back pain, scoliosis, kyphosis, joint pain, arthritis, lesions within the pelvis, chemotherapy or systemic diseases such as diabetes or systemic lupus erythematosis, were included in the study. A posterior planar image of the pelvis was performed to calculate the SI/S ratio 3 h after the injection of 740 MBq 99Tcm-MDP or 99Tcm-pyrophosphate. Twenty-five subjects were studied with 99Tcm-MDP and 21 with 99Tcm-pyrophosphate. We found the SI/S ratios using 99Tcm-MDP to be slightly higher than those using 99Tcm-pyrophosphate, especially on the left side, but this difference was not statistically significant (P-values > 0.1 on both sides using Student's t-tests for unpaired data).

Inhibition of N-type calcium currents by lamotrigine in rat amygdalar neurones

Lamotrigine (LAG) is a new anticonvulsant drug for the treatment of partial and secondarily generalized seizures. The present study was aimed at elucidating the possible involvement of Ca2+ channels in the action of LAG using whole-cell patch clamp recordings in acutely dissociated amygdalar neurones. Whole-cell Ca2+ currents (ICa) were elicited by 200 ms step commands from -70 mV to -10 mV. Application of LAG reduced the ICa by an average of 40.3 +/- 3.2%. The inhibition of ICa by LAG was markedly reduced or eliminated in the presence of the N-type Ca2+ channel blocker omega-conotoxin-GVIA (1 microM). These results suggest that LAG may exert its anticonvulsant effect through inhibition of presynaptic N-type Ca2+ channels, thereby reducing glutamate release.

Presynaptic inhibition of excitatory neurotransmission by lamotrigine in the rat amygdalar neurons

Lamotrigine (LAG) is a new antiepileptic drug which is licensed as adjunctive therapy for partial and secondary generalized seizures. In the present study, the mechanisms responsible for its antiepileptic effect were studied in rat amygdaloid slices using intracellular recording and whole-cell patch clamp techniques. Bath application of LAG (50 microM) reversibly suppressed the excitatory postsynaptic potentials (EPSPs) and currents (EPSCs) evoked by stimulating ventral endopyriform nucleus. Synaptic response mediated by the N-methyl-D-aspartate (NMDA) receptor (EPSPNMDA) was isolated pharmacologically by application of a solution containing non-NMDA receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX,10 microM) and gamma-aminobutyric acidA receptor antagonist bicuculline (20 microM). LAG produced a parallel inhibition of EPSPNMDA. Postsynaptic depolarization induced by alpha-amino-5-methyl-4-isoxazole propionate (AMPA) was not altered by LAG. In addition, LAG increased the ratio of the second pulse response to the first pulse response (P2/P1), which is consistent with a presynaptic mode of action. The L-type Ca+2 channel blocker nifedipine (20 microM) had no effect on LAG-induced presynaptic inhibition. However, the depressant effect of LAG was markedly reduced in slices pretreated with N-type Ca+2 channel blocker omega-conotoxin-GVIA (omega-CgTX-GVIA, 1 microM) or a broad spectrum Ca+2 channel blocker omega-conotoxin-MVIIC (omega-CgTX-MVIIC, 1 microM). It is concluded that a reduction in omega-CgTX-GVIA-sensitive Ca+2 currents largely contributes to LAG-induced presynaptic inhibition.

Comparison of bone mineral density between athletic and non-athletic Chinese male adolescents

For the evaluation of the effect of exercise on bone mineral density of adolescent athletes, twenty-nine Chinese male adolescent athletes, each of whom had regular training in his major sport which included baseball, swimming, judo and middle/long-distance running for one to six years and eight age-matched non-athletic controls were included in this study. Bone mineral density (BMD) was measured in all study subjects using dual photo absorptiometry at the second to fourth lumbar spines (L2-4) and the right femoral neck (FN). The results revealed the following: (1) the combined group of athletes had significantly greater BMD of L2-4 (1.08 +/- 0.09 g/cm2) than the control group (0.99 +/- 0.08 g/cm2) and a tendency for greater BMD of FN (1.15 +/- 0.13 g/cm2) than the control group (1.09 +/- 0.13 g/cm2); (2) judo majors had significantly greater BMD of L2-4 than baseball majors (P < 0.05), swimming majors (P < 0.01), track majors (P < 0.05) and controls (P < 0.005); (3) baseball majors had significantly greater BMD of L2-4 than controls (P < 0.05) and greater BMD of FN than swimming majors (P < 0.05), judo majors (P < 0.05), track majors (P < 0.005) and controls (P < 0.005); (4) body weight and body mass index (BMI) had good correlation with BMD of L2-4 and FN in control group, (5) in the combined group of athletes, weight and BMI were only strongly linked to BMD of FN, and not to BMD of L2-4. There was no good correlation between BMI and BMD of L2-4 and FN in any group of athletes. We concluded that (1) physical activity during adolescence may contribute significantly towards increasing BMD of athletes and (2) the training type may provide a specific stimulus for increasing BMD at specific localized sites experienced in training.

Variation of heart rate and electrocardiograph trigger interval during ultrafast computed tomography

OBJECTIVES

Electrocardiographic (ECG) trigger records obtained during cardiac ultrafast computed tomography (UFCT) scanning were analyzed to estimate the variability in heart rate and ECG trigger interval to develop a protocol that would allow the development of better ECG triggering software.

METHODS

One-hundred-eighteen patients underwent cardiac UFCT imaging for diagnostic purposes. All subjects were divided into three groups according to the heart rate and ECG trigger condition. Thirty slices were obtained in the high-resolution volume mode for each patient.

RESULTS

A decrease in heart rate and ECG trigger interval was found during image acquisition of the first four slices in all three groups. The nadir of the heart rate occurred during acquisition of the 4th slice, 5.3, 3.5, and 5.6 beats per minute less than the initial heart rate in groups 1, 2, and 3 respectively, with a 6.9%, 2.8%, and 5.0% shorter ECG trigger interval (p < .001, p = .08, p < .05, respectively). From the 4th to the 30th slices, heart rate and ECG trigger interval progressively increased, but less variability was found in the last 20 slices in all three groups.

CONCLUSIONS

Significant variation in heart rate and ECG trigger interval was seen during 30-level cardiac UFCT imaging, especially during image acquisition of the first four slices (approximately 1-6 seconds after breatholding). This can result in scanning during the suboptimal phase of the cardiac cycle by the current UFCT triggering software. A delay in the initiation of scanning to approximately 6 to 10 seconds after breatholding would result in imaging during a time when the heart rate is relatively stable, and a smaller variability in ECG trigger interval occurs. Recalculation of the required delay before each heart beat may improve the precision of ECG triggering.

Tc-99m HMPAO-labeled WBC scans to detect appendicitis in women

Fifty female patients with acute abdomen and suspected appendicitis but atypical findings were included in this study. After intravenous injection of Tc-99m HMPAO-labeled WBCs, serial anterior abdominal/pelvic images at 30, 60, 120, and 240 minutes were obtained by a gamma camera. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen with equal to or greater than bone marrow activity was considered as a positive scan. Thirty patients had positive WBC scans and underwent laparotomy, 28 had proven appendicitis, and 2 were not related to appendicitis. Twenty patients had negative WBC scans, 2 patients underwent laparotomy and were proved to have appendicitis. The remaining 18 patients did not undergo surgery and revealed no evidence of appendicitis after follow-up. The overall sensitivity, specificity, accuracy, and positive and negative predictive values for WBC scans to diagnose appendicitis is 93.3%, 90.0%, 92.0%, 93.3%, and 90.0%, respectively. In conclusion, Tc-99m HMPAO-labeled WBC imaging provides a rapid and highly accurate method for diagnosis of appendicitis in female patients with equivocal clinical examinations.

Short-term hazards of low-dose radioiodine ablation therapy in postsurgical thyroid cancer patients

During the last two decades, there has been a trend to use low-dose I-131 ablation therapy in patients with thyroid carcinoma without metastases. However, information regarding the incidence of acute adverse reactions in patients after low-dose radioiodine therapy has not been reported. In this study, the acute radiation effects after low-dose radioiodine ablation therapy in postsurgical differentiated thyroid cancer patients was evaluated. Fifty-six patients with differentiated thyroid cancer were prospectively evaluated. None of these patients had evidence of a distant metastasis. All patients received 40 mCi (1480 MBq) I-131 MIBG orally and were evaluated for symptoms and signs by a physician on the second and seventh days after therapy. Xerostomia and nausea were the most common complaints with the same incidence rate of 5.35%. Gastralgia occurred at a frequency of 3.57%. Pain in the thyroid bed, tenderness over a parotid gland, submandibular glands, change in taste, and vomiting all were found at a frequency of 1.78%. Maximum reactions generally occurred 24-48 hours after therapy. All the symptoms except for xerostomia resolved completely in most patients within a week. In comparison with high-dose ablation therapy published in the literature, the incidence of radiation reactions in low-dose radioiodine therapy was much lower. It was concluded that in patients without lymph node or distant metastases, low-dose I-131 MIBG therapy may be recommended to avoid the high incidence of local complications after high-dose treatment.

Bipolar disorder following a stroke involving the left hemisphere

OBJECTIVE

Post-stroke mania has rarely been noted and researched, and reported cases have mostly involved the non-dominant hemisphere. In this paper, we report a case of bipolar disorder secondary to a stroke over the dominant hemisphere.

CLINICAL PICTURE

A 48-year-old, right-handed man had a cerebral infarct over the left temporal region. He became depressed after the stroke, and 4 months later developed a manic episode.

TREATMENT

The patient was treated with haloperidol and lorazepam.

OUTCOME

The symptoms subsided within 2 months after treatment.

CONCLUSIONS

It is premature to consider mania to be a syndrome of the right, or non-dominant, hemisphere. We suggest that further study focusing on specific anatomical regions, rather than laterality, will help to elucidate the interrelationship between mood and brain function.